Baseline type 2 biomarker levels and clinical remission predictors in children with asthma.

Background: Few studies have investigated the relationship between baseline type 2 biomarker levels and clinical features in pediatric asthma, particularly in different asthma stages, which may inform prognosis and remission.

Objective: To explore the association between baseline Th2 biomarker levels and clinical manifestations in pediatric asthma, identifying predictors of clinical remission.

Methods: The study included 172 children with a mean age of 6.87 ± 3.04 years, comprising 119 asthma patients and 53 non-respiratory symptom controls. Clinical evaluations such as lung function tests, FeNO, total IgE, blood eosinophil counts, and skin tests were conducted. Serum biomarkers (TSLP, IL-4/5/13, TARC, Periostin), and IgE were measured by ELISA. Th2-high asthma (IgE >100 IU/mL and eosinophils≥140 cells/μL, n=110) was stratified into acute attack (n=48), persistent asthma (n=26), and clinical remission (n=36). Additionally, mouse models across asthma stages were established to measure TSLP levels in BALF, serum, and lung tissue, to validate its predictor value.

Result: Serum TSLP was significantly elevated in acute exacerbation and persistent asthma(P<0.01). Multivariable regression confirmed its independent association with remission (OR=1.009, P=0.023). ROC analysis indicated moderate discriminative capacity of TSLP for remission (AUC=0.59, sensitivity=39.1%, specificity=59.4%). Murine models also showed TSLP levels normalization during remission.

Conclusion: Serum TSLP is independently associated with clinical remission in Th2-high pediatric asthma, though its standalone predictive accuracy is moderate (AUC=0.59). Integration with lung function and IgE may form a composite biomarker panel for remission evaluation. This stratification tool may guide asthma risk stratification and personalized disease management. Longitudinal studies are warranted to validate its prognostic utility.